Primary Graft Failure Following Lung Transplantation

Christie, Jason D.; Bavaria, Joseph E.; Palevsky, Harold I.; Litzky, Leslie A.; Blumenthal, Nancy P.; Kaiser, Larry R.; Kotloff, Robert M.

doi:10.1378/chest.114.1.51

Cited by 294 publications

(210 citation statements)

References 23 publications

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“…These findings are consistent with reported mortality rates and relative risks in single-center studies for the most severe forms of PGD, including our own (1,2,5). In addition, a recent ISHLT registry report describes PGD as accounting for greater than 30% of mortality in the first 30 days, according to listed cause of death (14,19).…”

Section: Discussionsupporting

confidence: 89%

“…To compare the coded definition of PGD with patients at our institution, we extracted the charts of 188 subjects who underwent lung transplant at our institution between 1994 and 2000 and compared PGD based on detailed chart review with UNOS/ISHLT registry coding of PGD. We defined PGD according to our previously published criteria (1,8): a Pa O 2 /Fi O 2 ratio less than 200 beyond 48 hours after transplantation, with evidence of radiographic infiltrates, and absence of secondary causes of allograft dysfunction. An expanded and detailed explanation of our defining criteria is included in an online supplement.…”

Section: Definition Of Pgdmentioning

confidence: 99%

“…Occurring in the first hours to days after transplantation, the clinical course and pathophysiology of the most severe forms are most similar to the acute respiratory distress syndrome (1,3,4). With an incidence reported between 10 and 25%, and a high mortality (5), PGD represents the leading cause of early death after transplantation (1, 2, 5-8).…”

mentioning

confidence: 99%

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The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

Christie

Kotloff²,

Ahya³

et al. 2005

Am J Respir Crit Care Med

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302

212

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Rationale: Primary graft dysfunction is a severe acute lung injury syndrome after lung transplantation. Long-term outcomes of subjects with primary graft dysfunction have not been studied. Objectives: We sought to test the relationship of primary graft dysfunction with both short-and long-term mortality using a large registry. Methods: We used data collected on 5,262 patients in the United Network for Organ Sharing/International Society of Heart and Lung Transplantation registry between 1994 and 2000. We assessed outcomes in all subjects; to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least 1 year, using Cox proportional hazards models with time-varying covariates. Main Results: The overall incidence of primary graft dysfunction was 10.2% (95% confidence intervals [CI], 9.2, 10.9). The incidence did not vary by year over the period of observation (p ϭ 0.22). All-cause mortality at 30 days was 42.1% for primary graft dysfunction versus 6.1% in patients without graft dysfunction (relative risk ϭ 6.95; 95% CI, 5.98, 8.08; p Ͻ 0.001); among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least 1 year, those who had primary graft dysfunction had significantly worse survival over ensuing years (hazard ratio, 1.35; 95% CI, 1.07, 1.70; p ϭ 0.011). Adjustment for clinical variables including bronchiolitis obliterans syndrome did not change this relationship. Conclusion: Primary graft dysfunction contributes to nearly half of the short-term mortality after lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first post-transplant year.Keywords: acute lung injury; lung transplantation; outcomes; primary graft dysfunction; reperfusion injury Primary graft dysfunction (PGD), also known as primary graft failure, is a form of lung allograft ischemia-reperfusion injury (1, 2). Occurring in the first hours to days after transplantation, the clinical course and pathophysiology of the most severe forms are most similar to the acute respiratory distress syndrome (1,3,4). With an incidence reported between 10 and 25%, and a high mortality (5), PGD represents the leading cause of early death after transplantation (1, 2, 5-8).However, the long-term outcomes of PGD have not been (Received in original form September 20, 2004; accepted in final form March 3, 2005) Supported by grants NHLBI K23 HL04243 and the Craig and Elaine Dobbin Pulmonary Research Fund.Correspondence and requests for reprints should be addressed to

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Section: Discussionsupporting

confidence: 89%

Section: Definition Of Pgdmentioning

confidence: 99%

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The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

Christie

Kotloff²,

Ahya³

et al. 2005

Am J Respir Crit Care Med

Self Cite

302

212

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“…The lack of effect of graft ischaemic time, recipient sex, and recipient age upon development of primary graft failure has been reported by other groups, although it has been suggested that there is a time threshold for graft ischaemic time beyond which acute lung injury is more likely to occur [17,18]. Subsequent development of BOS has been related to early acute rejection, and no operative factors have been identified as risk factors for the development of this condition [19,20].…”

Section: Discussionmentioning

confidence: 92%

The effect of prelung transplant clinical status on post-transplant survival of children with cystic fibrosis

Aurora¹,

Gassas²,

Ehtisham³

et al. 2000

Eur Respir J

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The aim of this study was to determine whether transplanting paediatric cystic fibrosis (CF) patients later in the course of their disease was detrimental to their post‐transplant survival. Data was collected from 51 children with CF undergoing lung or heart‐lung transplantation May 1988–March 1999. The following risk factors were tested by Cox proportional hazards modelling: age at transplant; sex; donor/recipient sex mismatch; donor/recipient cytomegalovirus (CMV) mismatch; cold and warm graft ischaemic times; and donor age. Pretran‐splant forced expiratory volume in one second (FEV1), minimum oxygen saturation obtained during 12 min walk (Sa,O2min), and a survival probability score (SP) calculated from FEV1, age adjusted resting heart rate, age, sex, blood haemoglobin (Hb), and serum albumin were then added to the model. None of the risk factors were significantly correlated with death during the study period. No evidence that clinical status prior to transplant has any effect upon the post‐transplant survival of children with cystic fibrosis was found.

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“…104,105 However, these strategies have not been formally studied in organ donor populations. 106 Lung recruitment maneuvers utilizing high PEEP or pressure-controlled ventilation for short durations have been proposed as an adjunct to the lung protective strategies used in acute respiratory distress syn-drome. However, higher levels of PEEP must be used immediately after recruitment maneuvers in order to produce a sustained effect.…”

Section: Pulmonary Considerationsmentioning

confidence: 99%

Medical management to optimize donor organ potential: review of the literature

Kutsogiannis

Pagliarello

Doig

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. Sources:A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. Conclusion:Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients. Objectif

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Primary Graft Failure Following Lung Transplantation

Cited by 294 publications

References 23 publications

The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

The effect of prelung transplant clinical status on post-transplant survival of children with cystic fibrosis

Medical management to optimize donor organ potential: review of the literature

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